Saturday, January 04, 2014

Waiting for Bob...

Yeah, I know; sorry, TMI. But that little fact is fairly critical to the rest of this post, so I had to start with it. Try to scrub the image out of your brain. I'll wait.

OK, so, we good now?

Alrighty, then.

So, anyway, the bottom line is that as I headed into my forties I noticed that I was having some problems just dragging my ass out of bed in the morning. That and, well, the usual sort of problem associated with not being packed with robust man-juices, but we won't linger on that particular issue.

I went to see my internist, who ran the usual blood tests and pronounced me perfectly functional, 100% mission-capable.

Which left the issue of "Why the hell is my dead ass dragging so badly?" and I asked for a referral to a urologist. Since it didn't cost my GP a nickel she happily wrote out the referral and off I went.

The dick-doc then ran the same blood tests and proceeded to inform me that my natural testosterone levels were down there with those usually associated with very masculine women and pre-pubescent boys. I could creep up into the low three figures on a good day with a following wind and a strong current, but that was that.

So he prescribed me one of those artificial testosterone medicines that help professional bicycle racers win the Tour de France and off I went.

And the stuff works as advertised, let me tell you. In a couple of days I felt positively bursting with masculine energy; I wanted to seduce something or go start a war.

Kidding. But, seriously, the man-juice works. I felt "back to normal"; my energy levels in all respects returned to what I expected to feel given how active I was and how hard I worked to keep in shape and eat a healthy diet.

And because the urologist explained that this stuff was to restore my testosterone to natural levels as a matter of health and quality-of-life issues and not because I wanted to become some sort of mad harem-tester in my off-hours my insurance - after some initial suspicious sniffing - proceeded to cover the damn stuff.

Dick-stiffeners, though? Viagra? Cialis? Not a chance. Despite the usual whining about how all those boner pills are covered and female products aren't...they're actually not. That's just so you know the deal here.

Anyway, this was some ten years or so ago. I've been taking these testosterone supplements regularly ever since and, although the damn co-pays go up and up every year, paying just a portion of the actual price of the stuff.

Which is pretty ridiculous, mind you, given that the drug is decades old and is manufactured at some sort of drug-maquiladora in Mexico for probably pennies a dose. I mean, we're talking hundreds of dollars for a little pump-bottle that lasts about a month; well over $3,000 a year at full price.

Three. Thousand. Dollars.

But the damn insurance has been paying for this, so for the cost of $500/month or so in premiums I get a reliable supply of man-juice.

Until yesterday.

When my Bride returned from the grocery pharmacy without the testosterone bottle, explaining that the pharmacist had input the prescription and it had spit out that the drug was no longer covered by my Blue Cross/Blue Shield formulary.

So.

Now I am faced with the unlovely prospect of having to call my goddamn insurance company and 1) find out why the hell they are no longer covering my drug after ten years of doing so and 2) figure out how the hell I can get the goddamn insurance company to stop dicking around (if you'll excuse the expression) and cover the goddamn drug again. This will undoubtedly involved repeated conversations with unpleasant insurance company phone-bots whose purpose will be to find reasons not to spend the money I have been ladling into the goddamn insurance company's bank account on my health care.

And to make it as difficult and unpleasant for me to find a way to jerk that money out of their ass a nickel at a time.

And as I'm staring at my phone with a sense of deep loathing for this entire process, I keep thinking: remind me - this is that "best healthcare system in the world" we keep hearing about, right? Because we don't have some faceless bureaucrat deciding what and how we will get for our health care. Right?

Because right now I'm about ready to shove every goddamn insurance company up the gigantic bung-hole of the Universe and replace them with a single faceless government health care organization just like the one I had when I was a GI that paid for whatever my docs said I needed without so much as a whimper.

16 comments:

You are absolutely right -- our insurance system is a disaster. Big Pharma is a racket, and most doctors buy-in.

Who has the time for all of the phone-time and running around necessary to obtain the "prior auths" or re-visiting doctors, or all of the other hoops we are made to jump through to get what we need? What can be the upshot of this?

Higher premiums. We go without medications, and "need" more procedures as a result. Once the time for "Well Baby" visits is over, no one cares that you be a "well adult". You are a money machine, and how to get the most out of you?

I have very strong feelings on our medical system fiasco. Your experience is a small example of the problem repeated everywhere in the U.S. daily, ad infinitum. The costs are exorbitant and not reflective of the actual material, and people do not know how bungled it is for everyone (except those with Cadillac healthcare, i.e., politicos.)

There is some wrong-headed concept that poor people don't need to buy into Obamacare, and that they are covered by Medicaid. The dirty secret is, few doctors will accept Medicaid anymore, even if it is simply an adjutant to Medicare (which used to be the Gold standard.

I wonder why Americans think they have the best healthcare and are so afraid of losing it? It is simply a money-making system, one which wishes to "manage" your care versus helping you be well.

Really sorry to hear that chief. About the only thing the UK gets right is the NHS. You and your fellow citizens have every right to be totally p*ssed off with your system. It not only costs a fortune but it doesn't deliver.

But the vested interests will do (and have done) anything to maintain their grip. I'm not really sure how bad it has to get before something changes. The vested interests will ensure the country falls before they do.

All the usual suspects keep telling us that "we have the world's best healthcare" and like the fools we are, Lisa, most of us believe it, despite a huge pile of evidence to the contrary just like this.

That, and we have also been sold the notion that we're "cured" by medical intervention, while probably about 60-70% of all medicine consists of limiting damage so that our bodies can repair themselves. A healthy lifestyle and diet and good chromosomes are probably 80% of being well. Good medical care helps, sure, but I suspect less than we credit it. A hell of a lot of the money we spend on medicine comes in the last decade of our lives and much of that is effectively wasted; it just "keeps us alive", often in increasing pain and distress.

And the "poor people don't have to buy into Obamacare" is a canard, Lisa. Poor people don't have the money to "buy" into anything, but poor people get sick like everyone else. "Our" - that is, the society those people live in - options are only twofold; find some way to share the cost of caring for them, or let them sicken and die. "Doctors" - that is, the insurance syndicates that those practitioners belong to - should treat the sick and injured. Period. They should be compensated for it but to do as they do - simply try and bypass the sick and injured because they are poor - is an obscenity and a violation of the Hippocratic Oath they are supposed to revere.

Sorry, Leon. There is more in Heaven and Earth than is dreamt of in your philosophy.

DF: I'm afraid so. The medical care situation here is not all that different from the other plutocratic issues; the people who "matter" aren't affected by these problems, and the people who are don't "matter". That's why I keep talking about heads on pikes. Until the elites fear the result of their heedless greed there WILL be no change. The only time we HAVE seen change was when the greedsters crashed the U.S. economy amidst a time of communist and fascist revolutions and the frightening alternative these presented them forced them to back away from the levers of power.

The fact is that they did this again in 2008 and - lacking the threats to their safety from Left and Right - they suffered no ill effects other than a trifle of rhetorical flourishes. If the Lesser Depression has not produced a populist rebellion I cannot think of what will short of, as you suggest, a complete disaster.

And that, I'm afraid, is as likely to produce a Man on Horseback as it is a retreat to the social contract of 1932-1980...

I think we are the only "civilized" nation lacking a national healthcare. It must emerge from our brand of Christianity, which the believers feel confers favoritism upon the well-to-do. IOW, one must not be among the select if one is foundering, so tough luck.

Per you prescription, I have a guess:

Since testosterone is/should really be so cheap as no company has a patent on it, some company will come up will a chemical cognate which will cost many times as much and not be as effective. They will also create a marketing strategy to target women, as well. ("Poor sex drive? Load up on these here drugs." It couldn't possibly be that you're not simpatico with your lover, or you're exhausted, angry, etc.)

'Tis to make one scream, throw things…and yes, want to start a war. It is all a racket to put more money in the pockets of rich assholes.

We have plenty of models in Europe of how to do it better and yet we do not. Because here in America, every damned thing IS about making money to the point that the original purpose (medicine, education, etc) is totally lost or perverted.

Turns out that either the pharmacy people did a bad job explaining what was going on or my Bride had a bad time understanding it, but the upshot is that the 2014 rules change entails a $100 pharmaceutical "deducible".

So the cost wasn't $140; it was the normal $40 "co-pay" along with a one-time $100 "deductible". The next time I refill this med the out-of-pocket cost goes back to the usual 40 bucks.

So I'm left with this:

Why the fuck do insurance "rule changes" always seem, like casino "rules", to benefit the house?

How come your insurance company - you know, the one that likes to portray itself as this loving, caring friend of yours whose sole concern is your "good health" - never seems to find a way to provide MORE service for LESS money?

And how the fuck was having to spend thirty minutes of my time, on a day I took off from work just to have a little relaxation, with some faceless insurance company phone-bot explaining why their employer was jerking another hundred out of my wallet superior to the dreaded menace of some faceless "government bureaucrat" telling me the same thing?

Chief, I am glad it ultimately worked out for you. As I was reading the thread I was going to offer an alternative.

Two testosterone class drugs that we sometimes give to gelding thoroughbreds in training are winstrol and equipoise. They can't legally race on it and would be disqualified in the testing shed post race if they did, but it definitely enhances training gain. Makes a sluggish gelding perform like a raging stallion.

The cost is about $80/month - albeit veterinary grade (licensed vet cost) - for an animal that weighs in at half a ton +. You could probably stretch the $80 purchase to last four or five months (taking the full equine dose might make for an interesting blog post, though). Pretty good value.

I am told that people - like body builders - actually do take this stuff. There's a whole black market around this involving horse vets.

The moral here is that essentially the same drug/same dose is about $20/month if you're a horse, but exponentially higher for a human with healthcare insurance.

Why? Hint, it ain't the insurance companies wanting to pay out so much for a simple drug.

no one: Well, "worked out" in the sense that Regence Blue Cross got to jerk another hundred out of my pocket (on top of the fees they pull out of my paycheck, which ALSO went up this year) and in return I got the same damn thing I've been getting for almost a decade and didn't have to pay an extra hundred a year AND higher premiums for.

So I wouldn't excatly call that win-win.

And I suppose there's the always horse-medicine route. Used to work in the horse biz, and saw some people get pretty fucked up taking horse medicine.

So, um, no.

There's also a pretty well-established black market that goes through Canada for all of these pharmaceuticals still under patent in the U.S. The Canadian national health people uses the leverage they gets buying in bulk to get a price break, similar to that the military medical system gets.

Which brings me back to "WTF"? It's pretty well established that the fee-for-service-and-private insurance is a dead solid lock to drive costs up and service down. That's why the U.S, military has its own healthcare system that's effectively a single-payer system. I've used it, it works just fine and controls costs like a sonofabitch.

So there's a pretty commonsense way to avoid having to steal medicine from your horse and avoid going 10 rounds with the damn insurance company. We the People just haven't taken it, that's all.

Also, despite being more of a libertarian stripe, I do think a reasonable single payer national HC system would be best. I am skeptical it would be implemented properly and Obamacare tends to reinforce that perception.

A couple of caveats though; 1. Your car insurance does not pay for maintenance. You don't change the oil and the engine burns up, cost is on you. You have to buy your own tire replacements. Why should HCI pay for the human health correlate.

I mean auto insurance *could* pay for those things (might even prevent an accident that is costly to the company), but then auto insurance would be prohibitively expensive.

2. This - "On September 9, 1998, the Salinas Valley Memorial Hospital and the NASA Ames BioVIS (Biological Visualization, Imaging and Simulation) Technology Center signed a Space Act Agreement. This partnership gives the Hospital 3-D imaging capability for diagnostic analysis. These analyses can be transmitted by low orbiting satellites to any location on the earth. During June 1999, the Salinas Valley Memorial Hospital became one of medical facilities that hold the title, along with Stanford and Cleveland Research Clinic, “virtual hospital.” On July 21, 2004, the SVMHS and NASA signed a new Space Act Agreement, which enables them to work together on 3-dimensional, digital fusion-imaging projects.

Stanford affiliation with NICU

Since the Neonatal Intensive Unit opened in late 2001, it has worked with Stanford University's Lucile Packard Children's Hospital. The Salinas Valley Memorial Hospital and Stanford University are linked through an audio/video network, so they can transmit information about each baby if needed. The hospital has a Level III nursery which provides care for the most critical babies, including those who are premature." - It's really cool and might even provide some life saving benefit to someone. However, admissions at that hospital system are way more expensive than the state and regional avg. Those costs are passed along to all members as premium increases. Would your vision of a national HCI pay for this sort of thing? If so, where is the limit? What ceiling (as a % of GDP) would you put on HC expenditures as more and more whiz bang gizmos come on line?

The US is the only industrialized country to not regulate the price of prescriptions. Why should I pay $40 for a certain drug, while someone on say, Tricare, need only pay $12? A week-long antibiotic regime can cost over $100 in the U.S., versus $5 in Europe.

This lack of consistency means everything from root canals to GP visits cost more in the U.S. than in other industrialized nations.